Vaginal radiation brachytherapy to reduce central recurrence after radical hysterectomy for cervical carcinoma

Seventeen (17%) of one hundred and two patients were treated with radiation brachytherapy (without external-beam therapy) to the proximal vagina to reduce the possibility of central pelvic recurrence following radical hysterectomy for cervical carcinoma. The 17 were considered to be at greater risk of developing recurrent cancer in the central pelvis because the cancer invaded halfway through the cervix; however, no lesions extended beyond the cervix, nor were metastases to lymph nodes present or surgical margins involved. The brachytherapy treatment was evaluated for prevention of central pelvis recurrence and for related complications. The 17 women treated with radiation brachytherapy were also compared with 74 patients who did not receive brachytherapy after radical hysterectomy because their cancers were smaller and did not invade halfway through the cervix. Both groups were similar with respect to age (41 and 40 years, respectively), weight (69.5 and 65.9 kg), operative characteristics, and the proportions of squamous cell carcinoma and adenocarcinoma. Recurrences have not been observed among the patients treated with brachytherapy during a mean follow-up of 39 months (range, 9-92 months). No complications were attributed to the brachytherapy. However, two patients with large tumors refused adjuvant brachytherapy and suffered central pelvic recurrences. Brachytherapy in selected patients following radical hysterectomy was safely administered and appeared to reduce the risk of central pelvic recurrence.